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Exercise training: most gain with least pain?


Nowadays, exercise has been shown to be beneficial in different aspects of cardiovascular (CV) health: improved aerobic capacity, favourable adaptations of the CV system, better control of CV risk factors and improved prognosis, which led to the statement “Exercise is Medicine”.
Although the great importance of physical activity and exercise training is frequently demonstrated in cardiac patients, it remains largely obscure which characteristics and modalities of physical activity or exercise training (frequency, intensity, time, type - FITT) and volume (dose: intensity x duration) of exercise are most efficient at achieving the desired effect.
The aim of this scientific session, therefore, was to provide the latest information on the importance of high intensity interval training (HIIT) and its effect on the heart, the skeletal muscle and weight loss. Paul Beckers (BE) provided a nice history of exercise prescription and terminology. HITT is mainly meant for high performance athletic training and consists of short bouts (30 sec) of supra-maximal exercise. In the last few years, interval training has been introduced as a training modality in persons with CV disease or risk factors and has proven (although only in small studies) to be efficient. The HITT was, however, adapted to intervals of 4 min of exercise at 70-90% intensity levels and called aerobic interval training (AIT)
Although there is not enough scientific evidence in animal experiments and human studies to support the superiority of interval training in therapy of CVD, the speakers Massimo Piepoli (IT), Volker Adams (DE) and Gerald Fletcher (US) each concluded that there is undoubtedly enough scientific data to support its influence on functional capacity, remodelling of heart muscle, peripheral muscle metabolism and weight loss. Concerning weight loss, the amount of exercise is more important for weight loss than the intensity.
Thus, moderate intensity exercise performed for a longer time and, if necessary, weight bearing exercises are to be preferred.
Some of the present uncertainty concerning the potential superior role of AIT will be addressed in larger ongoing studies, SMARTEX in CHF and SAINTEX in CAD patients, and hopefully some of the doubts will be clarified after the results are published. 




Exercise training: most gain with least pain?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.